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Sexual dysfunction refers to a problem occurring during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle traditionally includes excitement, plateau, orgasm, and resolution. Desire and arousal are both part of the excitement phase of the sexual response.
While research suggests that sexual dysfunction is common (43 percent of women and 31 percent of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Because treatment options are available, it is important to share your concerns with your partner and health care provider.
Sexual dysfunction generally is classified into four categories:
Sexual dysfunction can affect any age, although it is more common in those over 40 because it is often related to a decline in health associated with aging.
Physical causes — Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of some medications, including some antidepressant drugs, can affect sexual function.
Psychological causes — These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, concerns about body image, and the effects of a past sexual trauma.
In most cases, the individual recognizes that there is a problem interfering with his or her enjoyment (or the partner's enjoyment) of a sexual relationship. The clinician likely will begin with a complete history of symptoms and a physical. He or she may order diagnostic tests to rule out any medical problems that may be contributing to the dysfunction, if needed. Typically, lab testing plays a very limited role in the diagnosis of sexual dysfunction.
An evaluation of the person's attitudes about sex, as well as other possible contributing factors (fear, anxiety, past sexual trauma/abuse, relationship concerns, medications, alcohol or drug abuse, etc.) will help the clinician understand the underlying cause of the problem, and will help him or her make recommendations for appropriate treatment.
Most types of sexual dysfunction can be corrected by treating the underlying physical or psychological problems. Other treatment strategies include:
Medication — When a medication is the cause of the dysfunction, a change in the medication may help. Men and women with hormone deficiencies may benefit from hormone shots, pills, or creams. For men, drugs, including sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®, Staxyn®), and avanafil (Stendra®) may help improve sexual function by increasing blood flow to the penis.
Mechanical aids — Aids such as vacuum devices and penile implants may help men with erectile dysfunction (the inability to achieve or maintain an erection). A vacuum device (Eros) is also approved for use in women, but can be costly. Dilators may help women who experience narrowing of the vagina.
Sex therapy — Sex therapists can be very helpful to couples experiencing a sexual problem that cannot be addressed by their primary clinician. Therapists are often good marital counselors, as well. For the couple who wants to begin enjoying their sexual relationship, it is well worth the time and effort to work with a trained professional.
Behavioral treatments — These involve various techniques, including insights into harmful behaviors in the relationship, or techniques such as self-stimulation for treatment of problems with arousal and/or orgasm.
Psychotherapy — Therapy with a trained counselor can help a person address sexual trauma from the past, feelings of anxiety, fear, or guilt, and poor body image, all of which may have an impact on current sexual function.
Education and communication — Education about sex and sexual behaviors and responses may help an individual overcome his or her anxieties about sexual function. Open dialogue with your partner about your needs and concerns also helps to overcome many barriers to a healthy sex life.
The success of treatment for sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a condition that can be treated or reversed. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.
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